Provider Demographics
NPI:1497063218
Name:TUCKER, DONALD JAMES (RPH)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:JAMES
Last Name:TUCKER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16013 N LAKEFOREST DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-1449
Mailing Address - Country:US
Mailing Address - Phone:623-815-9790
Mailing Address - Fax:623-815-9790
Practice Address - Street 1:7455 W CACTUS RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5399
Practice Address - Country:US
Practice Address - Phone:623-486-0441
Practice Address - Fax:623-979-4902
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10420183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist